Treatment of bacterial skin infections in ED observation units: factors influencing prescribing practice

UMMS Affiliation

Senior Scholars Program; Department of Emergency Medicine

Faculty Mentor

John Haran, MD/Emergency Medicine

Publication Date


Document Type



Adult; Age Factors; Aged; Anti-Bacterial Agents; Cohort Studies; *Emergency Service, Hospital; Female; Guideline Adherence; Humans; Male; Middle Aged; Practice Guidelines as Topic; *Practice Patterns, Physicians'; Sex Factors; Skin Diseases, Bacterial; Soft Tissue Infections


Bacterial Infections and Mycoses | Emergency Medicine | Skin and Connective Tissue Diseases


OBJECTIVE: The Infectious Disease Society of America (IDSA) publishes evidence-based guidelines for the treatment of skin and soft tissue infections. How closely physicians follow these guidelines is unknown, particularly in the emergency department observation unit (EDOU) where increasing numbers of patients are treatment for these infections. Our objectives were to describe (1) the antibiotic treatment patterns EDOU patients, (2) physicians' adherence to the IDSA guidelines, and (3) factors that influence physician's prescribing practices.

METHODS: This prospective cohort enrolled adult patients discharged from an EDOU at an academic medical center after treatment for a skin or soft tissue infection. Information was collected from chart review and patient interview pertaining to the patient's sociodemographic characteristics, presenting illness, and antibiotic treatment regimens. Treatment regimens were compared with national guidelines.

RESULTS: The study included 193 patients of which only 43% were treated according to IDSA guidelines, 42% were overtreated, and 15% were undertreated. Women were more likely to be undertreated (relative risk, 1.58; 95% confidence interval, 1.21-2.06), whereas patients 50 years and older were at risk for overtreatment (relative risk, 1.44; 95% confidence interval, 1.03-2.02). Women also received shorter courses of antibiotic therapy with an average of 9.6 days of treatment compared with 10.6 days for men.

CONCLUSIONS: Physician antibiotic prescribing practices demonstrated poor adherence to IDSA guidelines and were influenced by the patient's age and sex. Standardized antibiotic protocols for treatment of skin and soft tissue infections to IDSA guidelines in the EDOU would minimize physician bias.

DOI of Published Version



Am J Emerg Med. 2015 Dec;33(12):1780-5. doi: 10.1016/j.ajem.2015.08.035. Epub 2015 Aug 21. Link to article on publisher's site

Journal/Book/Conference Title

The American journal of emergency medicine


Gregory Wu participated in this study as a medical student as part of the Senior Scholars research program at the University of Massachusetts Medical School.

Related Resources

Link to Article in PubMed

PubMed ID